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This retrospective cohort study analyzed patients who underwent ovarian stimulation with rFSH or rFSH\u2009+\u2009HP-hMG following a gonadotropin-releasing hormone antagonist protocol, followed by fresh or frozen embryo transfer (ET) at two centers in Korea. A total of 1,028 women were included: 329 underwent fresh ET (rFSH:\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200978; rFSH\u2009+\u2009HP-hMG:\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u2009251) and 699 underwent frozen ET (rFSH:\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u2009250; rFSH\u2009+\u2009HP-hMG:\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u2009449). Across both fresh and frozen ET group, patients receiving rFSH\u2009+\u2009HP-hMG were older and had lower anti-M\u00fcllerian hormone levels and antral follicle counts. Despite fewer oocytes retrieved in rFSH\u2009+\u2009HP-hMG group (fresh: 9.5 vs. 11.0; frozen: 16.3 vs. 20.6, both\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.05), metaphase II oocyte rates and clinical pregnancy rates were comparable (fresh: 44.6 vs. 43.6%; frozen: 58.4 vs. 56.8%, both\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&gt;\u20090.05). Notably, ovarian hyperstimulation syndrome incidence was significantly lower in rFSH\u2009+\u2009HP-hMG group among frozen ET patients (6.9 vs. 13.2%,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.01). These findings suggest that rFSH\u2009+\u2009HP-hMG achieves comparable clinical outcomes to rFSH alone despite less favorable prognostic characteristics that could affect clinical outcome, supporting its role as a clinically acceptable alternative stimulation option in routine practice.\n                  <\/jats:p>","DOI":"10.1038\/s41598-026-51867-3","type":"journal-article","created":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T21:17:10Z","timestamp":1779225430000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparing clinical outcomes of rFSH versus rFSH+HP-hMG in women undergoing in vitro fertilization-embryo transfer in real\u2011world practice: a retrospective study"],"prefix":"10.1038","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5481-6062","authenticated-orcid":false,"given":"Myung Joo","family":"Kim","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jieun","family":"Ko","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donghee","family":"Choi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chan","family":"Park","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hye-Ok","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji Hyang","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jee Hyun","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yubin","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eun Jeong","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yun Jung","family":"Hur","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji Hye","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jieun","family":"Shin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"You Shin","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,19]]},"reference":[{"key":"51867_CR1","unstructured":"HFEA. 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Gynaecol."}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-51867-3","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-51867-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-51867-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T23:38:04Z","timestamp":1787701084000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-51867-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,19]]},"references-count":29,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["51867"],"URL":"https:\/\/doi.org\/10.1038\/s41598-026-51867-3","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,19]]},"assertion":[{"value":"15 January 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 April 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 May 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was conducted in compliance with the International Council for Harmonisation Good Clinical Practice and the Declaration of Helsinki. This retrospective observational study was conducted using medical records and was approved by the Institutional Review Board (IRB) of CHA Fertility Center Bundang and CHA Fertility Center Seoul Station (CHAMC2021-06-077-021 and GCI2021-10-003-014).","order":2,"name":"Ethics","label":"Ethics approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The requirement for informed consent was waived due to the retrospective nature of the study and the use of anonymized data.","order":3,"name":"Ethics","label":"Consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"26751"}}